What is Multiple Myeloma

Multiple myeloma is one of several diseases that are

collectively known as plasma cell dyscrasias. In
general, the term myeloma refers to cancer of special
types of white blood cells called plasma cells. Plasma
cells are important components of the immune
system that help the body fight infections caused by
microorganisms such as bacteria, viruses, and fungi.
Plasma cells are found primarily in the bone marrow
and develop from white blood cells called B-
lymphocytes. When microorganisms invade the body,
B-lymphocytes respond by transforming into plasma
cells which, in turn, produce proteins called
antibodies that help to destroy the invading
microorganisms and, thereby, eradicate the infection.
There are five types (classes) of antibodies
(immunoglobulins) produced by plasma cells: IgG,
IgM, IgA, IgD, and IgE. Each plasma cell produces a
specific class of antibodies.
Under normal conditions, the body only produces
plasma cells when they are needed to help fight off
infections. Once the infection has been eliminated
from the body, the old plasma cells die off. Certain
genetic mutations can cause plasma cells to become
abnormal and continue to divide over and over again
and, eventually, form a tumor. These abnormal
plasma cells, called myeloma cells are cancer cells
that produce a specific type of antibody (monoclonal
antibody) called M proteins. The monoclonal antibody
that is typically overproduced by the myeloma cells is
usually of the IgG or IgA variety. Most commonly, a
whole monoclonal antibody is produced, however, in
about 20% of cases, only a partial antibody called a
light chain is produced by the myeloma cells. Light
chains do not remain in the circulation and are found
mainly in the urine. The M proteins in patients with
multiple myeloma can be detected in the blood
and/or urine by specialized techniques known as
protein electrophoresis and immunofixation.
Since plasma cells originate from the bone marrow,
when plasma cells grow out of control, become
abnormal myeloma cells, and produce tumors, the
tumors usually develop in the bone marrow. If only a
single tumor is present, it is called a solitary
plasmacytoma. Typically, however, several tumors
can be found throughout the bone marrow and, in
these cases, the condition is called multiple
myeloma.
In patients with multiple myeloma, the number of
myeloma cells in the bone marrow increases
signficantly and usually accounts for more than 20%
of the total population of cells found in the bone
marrow. The abundance of cancerous plasma cells in
the bone marrow can lead to complications including:
Anemia - an abnormally low number of red blood
cells in the bloodstream that can cause
severe fatigue and weakness.
Thrombocytopenia - an abnormally low number of
platelets in the circulation that can lead to
bleeding and/or bruising problems.
Leukopenia - an abnormally low number of white
blood cells in the circulation that increases
the risk for developing severe, life-
threatening infections.
Myeloma bone disease - myeloma cells produce a
variety of substances (mediators) that
stimulate cells called osteoclasts to resorb
(dissolve) bone at a much faster rate than
cells called osteoblasts can produce new
bone. This increased rate of bone
resorption in patients with myeloma can
cause weak, brittle bones (osteoporosis)
and, thereby, increase the risk for
developing fractures.

Other underlying conditions that may be confused
with multiple myeloma because they
produce similar signs/symptoms and must
be considered in the differential
diagnosis of multiple myeloma.
How multiple myeloma is diagnosed based on
factors such as signs/symptoms, patient
history, physical examination, and special
laboratory tests such as serum protein
electrophoresis and immunofixation
The major and minor diagnostic criteria that
serve as the basis for confirming the
diagnosis of multiple myeloma.
A detailed overview of the two major
classification systems that are used by
doctors for **staging patients with
multiple myeloma into specific categories
based on the extent of the disease. These
2 classification systems, which play a key
role in both planning treatment and
predicting the outcome (prognosis) are
known as the:
Durie-Salmon staging system
International staging system
Understanding the Standard Treatments...and the
Treatment Options
Because currently there is no known cure for multiple
myeloma, understanding the standard treatments -
and the treatment options - is critical in attempting
to prolong survival and maintain the patient's overall
functional ability and quality of life. As you read
through the section of the Guidebook that focuses on
the treatments for multiple myeloma, you will
specifically learn about:
Which patients with multiple myeloma are
candidates for an approach known as
"watchful waiting", where the progress of
the disease is monitored carefully but no
specific treatment is required.
The various phases in the treatment of multiple
myeloma for patients whose disease has
progressed to the point where treatment
becomes necessary. These treatment
phases are grouped into the following
categories:
Initial or induction chemotherapy
Consolidation therapy
Maintenance therapy
Salvage therapy
The role of stem cell transplantation in the
management of patients with multiple
myeloma, including the risks and benefits
of this procedure.
The treatment options available to patients with
multiple myeloma who experience a
relapse or recurrence of the disease after
initially having gone into remission.
The role of plasmapharesis - the direct removal
of abnormal antibody proteins from the
bloodstream - in the management of
patients with multiple myeloma.
A detailed overview of the risk of infections in
people with multiple myeloma, including
practical recommendations for reducing the
risks of developing potentially life-
threatening bacterial, viral, and fungal
infections.
The treatment options that are available for the
management of patients with multiple
myeloma who develop myeloma bone
disease - areas of bone destruction
caused by multiple myeloma that
significantly increase the risk of developing
pathologic fractures.
The prognosis (outlook) for people with multiple
myeloma and important prognostic factors
that have a significant impact in predicting
the overall chances of recovery and
survival.
The role of complementary and alternative
therapies in the management of people
with multiple myeloma.
Quality of life issues such as sleep disorders,
fatigue, weight loss, and psychological
stress that often confront people with
multiple myeloma and tips for how to
minimize their impact and better cope with
these important issues.

Myeloma is a cancer that affects B cells, the immune
cells responsible for the production of antibodies.
Normal B cells develop in bone marrow. Myeloma
therefore affects bones. Multiple myeloma arises
when the cancer cells travel through the body and
form tumors in several different bones. Affected
bones may become brittle as the malignant cells
proliferate and alter the chemical equilibrium in the
marrow. Multiple myeloma is rarely diagnosed in
individuals under the age of 45.